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Ontario hospitals absorb health costs to treat refugees

One year after Ottawa cut refugee health funding, Ontario hospitals and Toronto-area refugees are picking up the tab.

Ingrid Lara filed a refugee claim in 2012, seeking protection from domestic abuse in Panama. While awaiting a decision, the 38-year-old was diagnosed in January with stage four breast cancer and is now undergoing chemotherapy treatment at Princess Margaret.
(DAVID COOPER / TORONTO STAR) | Order this photo

Canadian Doctors for Refugee Care raise a banner during at the North America Refugee Health Conference in Toronto on Thursday. A year after Ottawa's health cuts for refugees, visits by refugee patients to hospitals may be down, but taxpayers are not off the hook. (ANDREW FRANCIS WALLACE / TORONTO STAR) | Order this photo

A year after Ottawa cut health funding for refugees, Ontario hospitals are absorbing the costs or pursuing those patients for unpaid medical bills.

Hospitals in Greater Toronto are hardest hit by the changes, made effective by the federal government last June, since the majority of refugees are destined for this province.

The University Health Network — which includes Toronto General, Toronto Western and Princess Margaret hospitals, along with the Toronto Rehab Institute — expects to foot a total $800,000 bill this year for services delivered to the uninsured in its emergency rooms alone.

In other cases, refugees who fall sick are being billed by hospitals to pay for their medical care.

Ingrid Lara filed a refugee claim in 2012, seeking protection from domestic abuse in Panama. While awaiting a decision, the 38-year-old was diagnosed in January with stage four breast cancer and is now undergoing chemotherapy treatment at Princess Margaret.

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Under the old Interim Federal Health Program, her treatment and medications would have been fully covered. Instead, Lara says she is being asked to pay $2,000 for chemo, $4,500 for special white blood cell injections as part of her treatment, and $50 every three weeks for medication.

“I did not choose to have cancer,” said Lara, who had obtained a temporary work permit and was working as a bookkeeper until late February. ”It is stressful enough and I’m constantly thinking about my medical bills.”

Lara’s refugee claim was denied last week, meaning now her doctors’ visits will also no longer be covered. She plans to appeal the negative asylum decision.

Critics have long warned the federal government’s cuts to refugee health costs would simply be downloaded onto the provinces and individual hospitals, since they are obliged to treat patients in emergency cases and recoup fees later.

“What we are seeing is what we had anticipated,” said Dr. Meb Rashid of the Canadian Doctors for Refugee Care.

Anecdotally, he said uninsured patients are delaying seeking treatment, end up in emergency departments with more serious conditions and generate higher costs to the health system, he said.

“It’s an absolute mess.”

A spokesperson for Immigration Minister Jason Kenney said Friday the government has simply taken steps to ensure only legitimate refugees receive taxpayer-funded health care.

“It is very important to distinguish between a refugee, a refugee claimant, and a failed asylum claimant,” said Alexis Pavlich, Kenney’s press secretary.

“Canadians have been clear that they do not want illegal immigrants and bogus asylum claimants receiving free, gold-plated health care benefits that are better than those that Canadian taxpayers and seniors receive.”

Kenney has said the reforms will save taxpayers $100 million over five years.

Approximately 25,000 refugees arrive in Ontario each year, according to the Toronto Central Local Health Integration Network, a provincial agency that co-ordinates health care in the area.

In 2011, more than 61,000 refugees accessed the Interim Federal Health program in Ontario. Among them, 5,685 were resettled refugees, while 55,489 were refugee claimants, failed claimants and others.

While some hospitals are writing off these costs in their own budgets, others are resorting to collection agencies to retrieve the money from uninsured patients.

In one case, a failed refugee claimant from Liberia, who sought medical help in January for a cold at a walk-in clinic for the uninsured, was immediately sent to emergency when a doctor diagnosed him with extremely high blood pressure.

“I was hesitant to go, but they said I could have a heart attack or stroke any minute,” he said. He asked not to be identified so as not to jeopardize an outstanding spousal sponsorship application by his Canadian wife.

He ended up at The Scarborough Hospital, which charged him $10,000 for a four-day stay. With help from the Scarborough Community Volunteer Clinic, he tried to arrange a prepayment plan with the hospital, but was told in March that the bill had been referred to a collection agency.

A hospital spokesperson confirmed it uses a collection agency to seek payment for unpaid medical bills.

Catherine Pringle, a spokesperson for Trillium Health, which has sites in Mississauga and west Toronto, said the hospitals have noticed an increase in default payments from patients no longer covered by the federal program.

Other hospitals say they, too, are absorbing costs — $70,000 at the Toronto East General Hospital, $111,630 at St. Joseph’s Health Centre and $63,000 at St. Michael’s Hospital in the past year.

“There are a number of patients in the system, who were covered by the (federal) program, are no longer covered but for whom treatment must continue or death would result,” said Gillian Howard, at Toronto’s University Health Network.

The hospitals’ financial dilemma has renewed calls for the federal government to rescind the health-care cuts. A National Day of Action is planned on June 17 by health-care professionals and advocates across the country to boycott against the cuts.

“We recognize that some hospitals and other health-care facilities have been assuming health care costs that would otherwise have been borne by the federal government . . . I continue to call on the federal government to reverse their decision,” Ontario Health Minister Deb Matthews in an emailed statement to the Star.

“In the meantime, we continue to consider options available to the provincial government to mitigate the effects of this decision.”

At most hospitals now, patients must provide valid health insurance for elective care or prepay the fees.

“The ability to pay will not be a barrier to care and we will continue to serve the refugees living in our local catchment area,” said Dr. Ted Rogovein, chief of staff at St. Joseph’s Health Centre.

He added however: “St. Joseph’s does not have the capacity to provide services to all refugees in the GTA and so expects other hospitals to care for refugees in their local areas.”

Dr. Paul Caulford, of the Scarborough clinic for the uninsured, said the number of patients walking in with hospital bills seeking intervention has doubled, to three to four cases a month, from a year ago.

“Taxpayers are still on the hook,” he said. “The federal government has essentially downloaded the responsibility onto the shoulders of service providers, turning us into the police force to police the system, making us the bad guys.”

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